This application seeks support through the R34 mechanism to develop a program of research related to tailoring depression treatment to older adults and is submitted in response to RFA-MH-09-011 to develop innovative approaches to personalizing treatment for depression. This application grows out of an NIMH Sponsored Mentored Patient-Oriented Research Career Development Award (K23) entitled "Tailoring Depression Treatment to Older Adults." The 2001 IOM Quality Chasm report called for "patient-centered" care to improve the quality of behavioral health. The report listed respecting patients'values, beliefs and preferences and customizing care as keys to improving treatment uptake and benefit. We propose that for depression, treatment attributes are best derived from the patient's point of view, realizing that the scope of the attributes that patients may find most acceptable might lead to new constellations of treatments. In particular, this application aims to identify methods and variables that can be used to (a) characterize older adults with depression who would be likely to benefit from tailored treatment and (b) identify the valued aspects of various treatments that might be used to tailor or enhance existing treatments. The specific aims of this R34 are: (1) to identify values markers based on profiles of preferred treatment attributes and link them to personal and clinical characteristics including disease severity and treatment experience;and,(2) to assess the association between values markers and depression treatment initiation, adherence, and depression outcomes over a 12-week period. This application lays out a research plan unfolding in two phases. In Phase 1 we will interview 100 patients age 65 and older who meet criteria for major depression from the University of Pennsylvania health system to observe how individuals trade-off different treatments by assigning relative importance to particular attributes of a treatment using conjoint analysis. Conjoint analysis is a method that asks respondents to evaluate tradeoffs between conflicting characteristics of competing products or services, such as treatment options for depression. Conjoint will allow us to focus on the attributes of treatments as opposed to the preferences themselves. The results of conjoint analysis will allow us to identify profiles of treatment attributes (values markers). In Phase 2 we will offer patients antidepressant medication and/or psychotherapy to evaluate whether particular values markers are associated with adherence to medicine or interpersonal psychotherapy and with depression outcomes. The overarching goal of this R34 is to lay the groundwork for an R01 to test tailored depression treatment strategies for older adults with specific values markers predictive of treatment acceptability, adherence, and outcomes. Public Health Relevance: Although conventional depression treatments have been shown to be effective in treating older patients with depression, non-treatment or under-treatment for depression is common among older adults. Older adults are often more sensitive to drug side effects and more likely to have concomitant medical disorders, factors that make older adults more vulnerable to adverse consequences of treatments. The relative importance of various features of depression treatment may warrant a tailored treatment approach for the elderly.